Revenue Cycle Management Analyst III, Patient Financial Services

$76,107 - $114,171/Yr

Sutter Health - Sacramento, CA

Full-time - Mid Level

Remote - Sacramento, CA

Hospitals

About the position

The Revenue Cycle Management Analyst III position at Sutter Health is a critical role within the Patient Financial Services department, focusing on ensuring accurate and appropriate outpatient medical coding and documentation. This position involves coaching, training, and monitoring clinicians to enhance their coding practices. The analyst will be responsible for conducting encounter audits to monitor training success and will implement corrective action plans as necessary to ensure compliance with coding standards. As a local expert on Official Coding and Documentation Guidelines, the analyst will also be well-versed in various regulatory requirements, including those set forth by the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA). In this role, the analyst will utilize their advanced knowledge of the ICD-10-CM and CPT-4 Classification systems, as well as HCPCS and Evaluation and Management coding guidelines. They will understand the implications of data quality on prospective payment, utilization, and reimbursement across multiple medical specialties. The analyst will conduct coding audits, generate written reports with recommendations, and provide education and feedback to clinicians to facilitate improvements in documentation and coding practices. Additionally, the position requires a solid understanding of federal and state regulations, Medicare and Medicaid guidelines, and compliance issues. The ability to manage time effectively and handle projects is essential, as is proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint. Confidentiality regarding physician, patient, and personal data is paramount in this role.

Responsibilities

• Ensure accurate and appropriate outpatient medical coding and documentation through coaching, training, and monitoring of clinicians.
• Conduct encounter audits to monitor training success and implement corrective action plans as necessary.
• Serve as the local expert on Official Coding and Documentation Guidelines and regulatory requirements.
• Conduct coding audits and create written reports with recommendations for improvement.
• Present education and feedback to clinicians to facilitate improvement in documentation and coding practices.
• Maintain knowledge of relevant federal and state regulations, Medicare and Medicaid guidelines, and compliance issues.
• Utilize Microsoft Office applications to support coding and documentation processes.

Requirements

• Bachelor's degree in Business Administration, Public Health, Finance, or a related field.
• 5 years of recent relevant experience in medical coding and documentation.
• Advanced knowledge of ICD-10-CM and CPT-4 Classification systems, HCPCS, and Evaluation and Management coding guidelines.
• Proficient understanding of National Correct Coding Initiatives edits and ICD-CM Official Guidelines for coding and reporting.
• Ability to conduct coding audits and create reports with recommendations.
• Working knowledge of federal and state regulations, Medicare and Medicaid guidelines, and compliance issues.
• Strong time management and project management skills.
• Proficient in Microsoft Office applications including Word, Excel, and PowerPoint.

Benefits

• Comprehensive benefits package including health insurance, dental insurance, and vision insurance.
• Flexible work from home options.
• Paid time off and paid holidays.
• Retirement savings plan options.